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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 17 to 41 of 41. Go back in thread:
Posted by Phillipa on July 6, 2008, at 18:53:37
In reply to Re: Opiates, oxycodone, posted by undopaminergic on July 6, 2008, at 9:50:33
I need to find that doc then as l percocet makes me happy and being old means I really don't care about addiction. Valium for over 37 years prescribed at the time 70's was not considered bad and it worked. I went on to raise my family, run a business, and be magna cum laude in nursing school. Also many times over the years I simply stopped the valium and felt fine. No withdrawl was on the same dose then as now. But benzos do not work any longer pdoc said keep me out of withdrawal and to continue them. It's kind of sad to me that the newer meds that docs use some are involved in lawsuits. Makes me wonder. Like the fact that both these classes of meds have been around for decades and no bad things have come out. This is just my opinion. Love Phillipa
Posted by blueboy on July 7, 2008, at 18:21:49
In reply to Re: Opiates, oxycodone, posted by undopaminergic on July 6, 2008, at 9:50:33
> >
> > This is especially interesting because, if a doctor in the US prescribed oxycodone for a long period of time to a person to treat a "psychological" condition, he would lose his license and be sent to prison.
> >
>
> That's not true. There is nothing illegal about prescribing opiates for depression or other conditions where they are found useful. It's also being done, but not as often as it ought to.I've reviewed some literature on the internet and it seems that I was wrong about this. My apologies.
Posted by cactus on July 8, 2008, at 3:03:38
In reply to Re: Opiates, oxycodone, posted by blueboy on July 7, 2008, at 18:21:49
it's the same in my country too, the only way to get it is if you are a know heroin user
Posted by okydoky on July 8, 2008, at 8:26:40
In reply to Re: Opiates, oxycodone, posted by undopaminergic on July 4, 2008, at 12:09:06
I am seeing this new doctor today and am told he will prescribe opiates if I provide evidence I am already on them or anything else for that matter. In that vein I am going specifically to ask him to prescribe Subutex. I know he prescribes it too but not sure about the DEA problem like I had with the previous doc. Even with the DEA letter he was too afraid. Anyway from every conversion thing I read that I could find and there were few, It looks like 3.6mg would be an equivalent dose. Of course at least as a [pill it does not come in this dose anyway. I read one is supposed to start with less than equivalent dose when changing pain meds. Any suggestions on how to "manipulate" the conversation with him to my advantage. (Him prescribing the Subutex) And suggestion as to starting dose? I plan on bringing a copy of the letter with me bu perhaps it would be better not to bring it up unless absolutely necessary? I want to ask him for something to sleep too. Perhaps it would be advisable to do one thing at a time and not bring that up today? Of course I will be influenced by his demeanor ect. Originally I wanted to try it because my urologist suggested it for pan and it was suggested on this site on theory that t*t might work better with Amineptine. I also thought it might help with any tolerance as I will be taking opiates probably the rest of my life. Recently I have had to increase my oxycontin use from 20mg bid to 30mg bid. The last month or so after about 5 years use. But in the last few weeks I had a lot of breakthrough pain and was very depressed and started snorting my 5mg ir oxys. The last week or so I started snorting 10 or 15mg at a time and not of pain necessity. I think it would be better if I left this information out today, although it might be usefull?
My appointment is at 1pm. I know this is last minute so no one might get to this before I go. It would be appreciated if anyone has the time.
Thanks,
oky
Posted by okydoky on July 8, 2008, at 14:21:36
In reply to Re: Opiates, oxycodone, posted by okydoky on July 8, 2008, at 8:26:40
I went to this new doctor and he said that I was pretty much a mess. He said he was willing to help me and had dealt with complex cases before and with interstitial cystitis but was insistent that I had to trust him an not further complicate things by not being compliant. Said it was ok to have input but... Then he prescribed methadone and said something about NMDA and long and short term pain relief was better with it.I am upset as I do not know him yet to trust him. I have been mistreated and treated poorly by several doctors in the past and have difficulty trusting anyway. I just met him! He said he did not prescribe Suboxone or Subutex and said it was not used for pain even while I told him it was. I was told by the person who suggested him that he did prescribe Suboxone so I am left to ponder.
What about Methadone for pain and it being better as far as my depression is affected?
oky
Posted by bottlecappie on July 8, 2008, at 16:23:29
In reply to Re: Methadone NMDA, posted by okydoky on July 8, 2008, at 14:21:36
It's my understanding that methadone is better for chronic pain than buprenorphine (active ingredient in subutex/suboxone). Subutex & suboxone are only approved in the US for treatment of opiate dependency.
If you are suffering a lot of chronic pain and also have breakthrough pain, subutex might not be a good choice for you because buperenorphine binds so tightly to opiate receptors that it basically renders all other opiate medications ineffective. So, if the subutex wasn't handling your pain, you'd be stuck.
There are some doctors who prescribe subutex/suboxone for pain, but it's my understanding that this is usually done in cases where addiction/dependency is also an issue. It's more difficult to abuse suboxone/subutex because buprenorphine has a ceiling effect.
I currently take suboxone for opiate dependency and it works wonderfully to supress withdrawals and the desire to use. It's a mediocre pain-reliever, in my opinion. It works well for my fibromyalgia but is not great for acute pain or headaches. I do believe it works well as an antidepressant, as that has been my experience, and I was able to discontinue Wellbutrin since I've been on suboxone.
I also took methadone in the past and found it to help with my depression and it was an extrememly effective pain reliever. It lasts for a long time and didn't produce the cravings associated with shorter-acting opiates. It is addictive, as all opiates are, so you might want to be aware of that.
Good luck, and I hope you'll be feeling better soon.
Posted by Sigismund on July 8, 2008, at 19:00:54
In reply to Re: Methadone NMDA, posted by bottlecappie on July 8, 2008, at 16:23:29
I wonder if any opiate (given a flattish blood level) will, once dependence is attained, be of very minimal use?
That said, the advantage of bupe as I understand it, is that there is less depression than with methadone and it is not so difficult to get off.
Certainly methadone is strong enough. But what this means in practice with once a day doseage is that you are affected (pain relief) for maybe weeks, and then you arrive at a steady state situation where you feel better for a few hours after your dose and that is it for the day.
More frequent doseage will not make this better. Blood levels will be flatter still, and therefore the incremental improvement will be extremely shortlived after a dose.
Of course there are worse things than being on methadone, like being in terrible pain. But I don't know how much pain relief you can expect long term.
What is the NMDA thing about?
Posted by okydoky on July 8, 2008, at 20:15:33
In reply to Re: Methadone NMDA, posted by bottlecappie on July 8, 2008, at 16:23:29
It was referenced for me about antidepressants but I cannot remember where. Here is one of many I found when searching psycho-babble not to do with me though: http://www.dr-bob.org/babble/neuro/20080204/msgs/820576.html
I just don't understand nor remember the information . I feel like a jerk.
oky
Posted by okydoky on July 8, 2008, at 20:36:39
In reply to Re: Methadone NMDA, posted by okydoky on July 8, 2008, at 20:15:33
I forgot to say the doctor had made mention of NMDA and kind of mumbled something about it and methadone and depression. Which is the reason I brought it into the conversation.
I know I make everything into a crisis. I just had been feeling quite hopeless and unrealistically had pinned everything on this one meeting with a doctor I had never met.
oky
Posted by garylee on July 10, 2008, at 13:57:42
In reply to Re: Methadone NMDA, posted by okydoky on July 8, 2008, at 20:36:39
> I forgot to say the doctor had made mention of NMDA and kind of mumbled something about it and methadone and depression. Which is the reason I brought it into the conversation.
>
> I know I make everything into a crisis. I just had been feeling quite hopeless and unrealistically had pinned everything on this one meeting with a doctor I had never met.
>
> oky
>Hi All
My brother has been taking Meth for about 7 years now for his depression. It gives him energy and he's able to get up and unction 'fairly' normally day to day. He hasn't changed his dose in the whole time of taking it, and I believe he only takes a tiny dose compared to Heroin users.
Unfortunatley he has to get it illegally as docs in the UK will not and cannot prescribe for Bipolar or depression of any kind, it's for Heroin addicts only and you have to visit a Drugs and Alcohol clinic for it.
I too have tried Meth, didn't do alot for me, I have a very high tolerance to all meds, have always seemed to have to take to highest doses to get any benefits. Subutex on the other hand almost brought me into remission, just on 4mg at night. I was a different person. It pooped out after a month or s though, and the consipation was terrible! I'd like to try Suboxone (with Naltrexone) next, see if the tolerance doesn't come into the equation...
Opiates should be an option for all Treament Resistant Depression, it's just the few that abuse it that ruin it for the rest of us. My 2 cents anyway...
Gary
Posted by okydoky on July 13, 2008, at 23:42:04
In reply to Re: Methadone NMDA, posted by garylee on July 10, 2008, at 13:57:42
I have tried Avinza (morphine) for three days now. Having been on oxycontin for years I cannot believe how much better I feel mentally on the Avinza. Several people are trying Subutex or Suboxone for depression or have been using it.
I have not found any published material comparing different opiates as antidepressants. It would be interesting to read and helpful most especially to those of us in need of pain meds anyway and useful for those of us with trd.
Does anyone know of any published materials? I found a bit about meth or morphine etc. but nothing comparing any of them. Or have any theories as to which one(s) might be most effective?
Posted by Sigismund on July 13, 2008, at 23:53:21
In reply to Opiates for depression what's best?, posted by okydoky on July 13, 2008, at 23:42:04
>I have tried Avinza (morphine) for three days now. Having been on oxycontin for years I cannot believe how much better I feel mentally on the Avinza.
Makes absolute sense to me.
The main drawback is the constipation.
Posted by okydoky on July 14, 2008, at 0:14:51
In reply to Re: Opiates for depression what's best? » okydoky, posted by Sigismund on July 13, 2008, at 23:53:21
Why does it make sense? I don't know yet if the constipation is any worse than I have on the oxycontin. Dealt fine on 40mg/day on 60 did not have it under control yet but I think I would have given time. Lots of fiber and some magnesium and drink a lot of fluids every day. I guess I will know soon enough:)
oky
Posted by okydoky on July 27, 2008, at 12:54:22
In reply to Re: Opiates for depression what's best? » okydoky, posted by Sigismund on July 13, 2008, at 23:53:21
Since you brought it up:)
I thought I could continue to keep the constipation under control but when I increased the oxycontin I never completely had a handle on it and it continues to be a problem on Avinza.
I thought perhaps the pain specialist I am to see on August 4th might have some answers but in the mean time any suggestions?
oky
Posted by Crotale on July 27, 2008, at 14:53:50
In reply to Re: The main drawback is the constipation » Sigismund, posted by okydoky on July 27, 2008, at 12:54:22
That's my experience with opioids also. The constipation and the itching. The latter can be dealt with using nondrowsy antihistamines like loratadine. (Benadryl has the potential to cause constipation, which is not what you want more of!)
Some high-fiber foods...well, there are some really tasty cereal bars out there. Also, stick to bread and pasta with whole-grain. Umm...there are really quite a few things you can eat, if you have the fortune to have an appetite :-}, that will help keep the constipation under control. Unfortunately, at least in my experience (been on buprenorphine for nearly 10 years), this side effect does *not* go away with time.
What dose Oxycontin are you on? What about the morphine? and why are you on both of those (if I may ask???)
-Crotale
Posted by okydoky on July 27, 2008, at 19:53:40
In reply to opioid side effects, esp. constipation » okydoky, posted by Crotale on July 27, 2008, at 14:53:50
I'm not on both. I was on 40mg/day Oxycontin for several years and recently had increased it to 60mg. About three weeks ago I changed to Avinza.
I eat greens, steel cut oats, raw vegetables almost daily. I am mostly vegetarian. How else could I change my diet?
I tried and cannot control it naturally at least not if I am on this dose. I took "Citrucel" and milk of mag every day for 5 years and until I increased the oxycontin, then changed to Avinza I could control it quite well. I could try taking more of the same again but I was thinking maybe "miralax" or something else? The digestive problems are causing further inflammatory problems with my bladder disease and joints. So besides the obvious I need to get it under control.
Posted by Crotale on July 27, 2008, at 20:14:15
In reply to Re: opioid side effects, esp. constipation, posted by okydoky on July 27, 2008, at 19:53:40
Ouch! That sounds pretty tough. What dose of morphine are you on? I'm not too familiar with oxycodone doses, a little more so with oral morphine (although more with parenteral morphine).
I've had some success with a couple of cereal bars that have quite a lot of fiber in them. Unfortunately I'm out (need to go grocery shopping). My experience is that whole grains are better for the GI stuff than green veggies, although if MOM isn't helping you....
What has your internist or pain specialist to say about your problem? If they have experience prescribing opioids then they should also have plenty of experience helping patients deal with constipation.
sympathetically yours,
-Crotale
Posted by okydoky on July 27, 2008, at 20:24:34
In reply to Re: opioid side effects, esp. constipation » okydoky, posted by Crotale on July 27, 2008, at 20:14:15
I'm not on a lot of morphine. It is time release an I do not know the equivalent dose of regular morphine. Avinza 90mg.
I have not seen a pain specialist yet. My first appointment is on August 4th. My pdoc originally prescribed and the last few years my urologist has been prescribing my pain medications.
Inoticed the oats help me more than any other food but I can only eat so much of it.
Posted by Crotale on July 27, 2008, at 21:11:48
In reply to Re: opioid side effects, esp. constipation, posted by okydoky on July 27, 2008, at 20:24:34
> I'm not on a lot of morphine. It is time release an I do not know the equivalent dose of regular morphine. Avinza 90mg.
The total daily dose would be the same for immediate-release morphine. I wish I knew the equivalent for parenteral [injected] morphine. I take buprenorphine (approximately 0.2mg (= 2/3 mL) q.i.d.) by deep intramuscular injection. The equivalent dose of morphine - IM - is supposedly 0.3mg bpn = 10mg morphine. But again, that is IM morphine, not oral. (Buprenorphine is not absorbed orally.)
> I have not seen a pain specialist yet. My first appointment is on August 4th. My pdoc originally prescribed and the last few years my urologist has been prescribing my pain medications.
Urologist should definitely be able to help with the constipation! What I should have said was "call the prescribing doctor." Sorry about that.
> Inoticed the oats help me more than any other food but I can only eat so much of it.
I'll try and find the name of those cereal bars I like to munch on (I'm mostly veg too). They're really high in fiber, I think they even have "fiber" in the name. You might check out Kashi cereals and cereal bars, those are tasty IMO and a lot of them are high in fiber. I'll try and find some other high-fiber foods and drinks when I get to the grocery store. (I remember there was a very high-fiber fruit drink I used to be able to get, until the local market stopped carrying them, argh.)
In the meantime best of luck to you! Let me know if there's any other way I can help. I know what a pain in the *ss (so to speak) constipation can be!
-Crotale
Posted by Larry Hoover on July 28, 2008, at 9:53:32
In reply to Re: The main drawback is the constipation » Sigismund, posted by okydoky on July 27, 2008, at 12:54:22
> Since you brought it up:)
>
> I thought I could continue to keep the constipation under control but when I increased the oxycontin I never completely had a handle on it and it continues to be a problem on Avinza.
>
> I thought perhaps the pain specialist I am to see on August 4th might have some answers but in the mean time any suggestions?
>
> okyWell, been there. I totally understand.
My pain specialist recommended prunes. They not only contain fiber, but also a bowel stimulant. His recommendation was one prune for each 5 mg of oxycodone.
Most of the time, that was enough. When that didn't work, I turned to stimulant herbs, such as senna. I don't know if it's widely available, but I found a product called Metab Herb (a blend that includes senna) to be quite effective. And when that didn't work, I resorted to a Fleet enema. So long as you don't use a Fleet very often, they're totally safe. Used too frequently, they can lead to electrolyte imbalances.
Lar
Posted by okydoky on July 28, 2008, at 11:44:34
In reply to Re: The main drawback is the constipation » okydoky, posted by Larry Hoover on July 28, 2008, at 9:53:32
I tried prunes but it was a long time ago it might be worth another try as I woke up today with the problem again.
I do take senna or "Senokot" now about two or three times a week It is very helpful. Perhaps I need to take it routinely.
I am recalling now that my prescribing doctor originally prescribed "Miralax" but it put me in the hospital with dehydration. I think he prescribed it too often and too much for what I needed at the time. What do you think of its' mode of action?
I use to do enemas almost routinely. I do not know why but most of the time it made my bladder "flare". My theory is the additional fluid prompted some toxins to get into my body or bloodstream. It was pretty bad sometimes so I stopped going that route although I prefer it s a more healthy and natural way to alleviate constipation. I guess that sound kind of funny. Only to routes to go right:)
Posted by elanor roosevelt on July 29, 2008, at 0:07:59
In reply to Re: The main drawback is the constipation, posted by okydoky on July 28, 2008, at 11:44:34
take mirolax
start with a low dose
Posted by okydoky on July 29, 2008, at 11:36:58
In reply to Re: The main drawback is the constipation, posted by elanor roosevelt on July 29, 2008, at 0:07:59
Thanks for the suggetion but can you tell me why you think this is the route to take?
Posted by Quintal on July 29, 2008, at 13:25:22
In reply to Re: The main drawback is the constipation, posted by okydoky on July 29, 2008, at 11:36:58
People having constipation with buprenorphine might want to try the Suboxone preparation instead. This formulation was found to reduce/eliminate the constipation side effect. Naloxone blocks the opioid receptors as it passes through the GI tract (after being swallowed in saliva). It isn't absorbed from the oral mucosa or GI tract in significant quantities and doesn't intefere with the therapeutic effect of buprenorphine.
Q
Posted by okydoky on July 29, 2008, at 13:50:21
In reply to Re: The main drawback is the constipation, posted by Quintal on July 29, 2008, at 13:25:22
Thannks Q. How are you today?
First I have to decide whether I am going to try either of them for pain control and then I have to find a doc who will prescribe. Been problematic so far.
This is the end of the thread.
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